INVESTIGATORY PROJECT

IN
BIOLOGY

BY,
B.H.SOORYA
RAO

KENDrIYA VIDYALAYA
VIJAYANARAYANAM
PROJECT REPORT BIOLOGY
2014 - 2015
NAME: B.H.SOORYA RAO
STANDARD: XII th
ROLL: 1123
TITLE OF THE PROJECT:

EPILEPSY- A NEUROLOGICAL
DISORDER

CERTIFICATE:

This is to certify that

B.H.SOORYA RAO of class XII
studying in Kendriya Vidyalya
Naval Base vijayanarayanam
has completed his
investigatory project of
biology on the topic
EPILEPSY A NEUROLOGICAL
DISORDER and has given a
satisfactory account in his
record.

Acknowledgement:
I feel proud to present my investigatory project in
Biology on the
DETERMINATION OF THE CONTENTS OF
COLD DRINKS
This project would not have been feasible without the
proper rigorous guidance of biology teacher
Mrs.K.Anisha. Who guided me throughout this project
in every possible way? An investigatory project
involves various difficult lab experiments, which have
to obtain the observations and conclude the reports
on a meaningful note. There by, I would like to thanks
Mrs.K.Anisha for guiding me on a systematic basis
and ensuring that in completed all my research with
ease. Rigorous hard work has put in this project to
ensure that it proves to be the best. I hope that it
proves to be the best. I hope that this project will
prove to be a breeding ground for the next
generation of students and will guide them in every
possible way.

INTRODUCTION
SIGNS AND SYMPTOMS
CAUSES
PARTHOPHYSIOLOGY
CLASSIFICATION
SEIZURE TYPES
EPILEPSY SYNDROMES
MANAGEMENT
MEDICATION
SURGERY
OTHERS
DEATH
HISTORY
SOCIETY AND CULTURE
LEGAL IMPLICATION
NOTABLE CASES
REFERENCE

EPILEPSY
Epilepsy (from the Ancient Greek (epilpsa)
"seizure")
is
a
common
and
diverse
set
of chronic neurological
disorders characterized
by seizures. Some definitions of epilepsy require that
seizures be recurrent and unprovoked, but others
require only a single seizure combined with brain
alterations which increase the chance of future
seizures.
Epileptic seizures result from abnormal, excessive
or hyper-synchronous
neuronal
activity in
the
brain. About 50 million people worldwide have
epilepsy, and nearly 90% of epilepsy occurs in
developing
countries. Epilepsy
becomes
more

common as people age. Onset of new cases occurs

most frequently in infants and the elderly. As a
consequence of brain surgery, epileptic seizures may
occur in recovering patients.
Epilepsy is usually controlled, but not cured, with
medication. However, over 30% of people with
epilepsy do not have seizure control even with the
best
available
medications. Surgery may
be
considered in difficult cases. Not all epilepsy
syndromes are lifelong some forms are confined to
particular stages of childhood. Epilepsy should not be
understood as a single disorder, but rather as
syndromic with vastly divergent symptoms, all
involving episodic abnormal electrical activity in the
brain and numerous seizures.

Epilepsy
Classification and external resources

Generalized 3 Hz spike and wave discharges in EEG

ICD-10

G40-G41

ICD-9

345

Diseases
D.B.

4366

Medline
Plus

000694

e-Medicine neuro/415
MeSH

D004827

Epilepsy is characterized by a long term risk of

recurrent seizures. These seizures may present in a
number of different ways.

The diagnosis of epilepsy usually requires that the

seizures occur spontaneously. Nevertheless, certain
epilepsy syndromes require particular precipitants or
triggers for seizures to occur. These are termed reflex
epilepsy. For example, patients with primary reading
epilepsy have
seizures
triggered
by
reading. Photosensitive epilepsy can be limited to
seizures triggered by flashing lights. Other

precipitants can trigger an epileptic seizure in

patients who otherwise would be susceptible to
spontaneous
seizures.
For
example,
children
with childhood absence epilepsy may be susceptible
to hyperventilation. In fact, flashing lights and
hyperventilation are activating procedures used in
clinical EEG to help trigger seizures to aid diagnosis.
Emotional stress, sleep deprivation, sleep itself, heat
stress, alcohol and febrile illness are examples of
precipitants cited by patients with epilepsy. Notably,
the influence of various precipitants varies with the
epilepsy syndrome. Likewise, the menstrual cycle in
women with epilepsy can influence patterns of
seizure recurrence. Catamenial epilepsy is the term
denoting seizures linked to the menstrual cycle.
There are different causes of epilepsy that are
common in certain age groups.

During late infancy and early childhood, febrile

seizures are fairly common. These may be caused
by many different things, some thought to be
things such as CNS infections and trauma.

During
childhood,
well-defined
syndromes are generally seen.

epilepsy

During adolescence and adulthood, the causes

are more likely to be secondary to any CNS lesion.
Further, idiopathic epilepsy is less common. Other
causes associated with these age groups are
stress, trauma, CNS infections, brain tumors, and
illicit drug use and alcohol withdrawal.

In older adults, cerebro-vascular disease is a very

common cause. Other causes are CNS tumors,
head trauma, and other degenerative diseases that
are common in the older age group, such
as dementia.
When investigating the causes of seizures, it is
important to understand physiological conditions that
may predispose the individual to a seizure
occurrence. Several clinical and experimental data
have implicated the failure of bloodbrain barrier
(BBB) function in triggering chronic or acute
seizures, some studies implicate the interactions
between
a
common
blood
protein
albumin and atrocities. These findings suggest that
acute seizures are a predictable consequence of
disruption of the BBB by either artificial or
inflammatory mechanisms.

Mutations in several genes have been linked to some

types of epilepsy. Several genes that code
for protein subunits
of voltage-gated and
ligandgated ion channels have been associated with forms
of generalized epilepsy and infantile seizure
syndromes.
One speculated mechanism for some forms of
inherited epilepsy are mutations of the genes that
code for sodium channel proteins; these defective
sodium channels stay open for too long, thus making
the neuron hyper excitable.
Glutamate, an
excitatory neurotransmitter, may, therefore, be
released from these neurons in large amounts, which
by binding with nearby glutamatergic neurons
triggers excessive calcium (Ca2+) release in these
post-synaptic cells. Such excessive calcium release
can be neurotoxin to the affected cell. The
hippocampus, which contains a large volume of just
such glutamatergic neurons (and NMDA receptors,
which are permeable to Ca2+ entry after binding of
both glutamate and glycine), is especially vulnerable
to epileptic seizure, subsequent spread of excitation,
and possible neuronal death. Another possible
mechanism
involves
mutations
leading
to

ineffective GABA (the brain's most common inhibitory

neurotransmitter) action. Epilepsy-related mutations
in some non-ion channel genes have also been
identified.
Much like the channelopathies in voltage-gated ion
channels, several ligand-gated ion channels have
been linked to some types of frontal and generalized
epilepsies.
Epileptogenesis is the process by which a normal
brain develops epilepsy after trauma, such as a
lesion on the brain. One interesting finding in animals
is that repeated low-level electrical stimulation to
some brain sites can lead to permanent decrease in
seizure "threshold." This phenomenon, known
as kindling (by analogy with the use of burning twigs
to start a larger fire) was discovered by Dr. Graham
Goddard in 1967. It is important to note that these
"kindled" animals do not experience spontaneous
seizures. Chemical stimulation can also induce
seizures; repeated exposures to some pesticides
have been shown to induce seizures in both humans
and animals. One mechanism proposed for this is
called excito-toxicity. The roles of kindling and excitetoxicity, if any, in human epilepsy are currently hotly
debated.

Epilepsies are classified in five ways:

1.By their first cause (or etiology).
2.By the observable manifestations of the seizures,
known as semiology.
3.By the location in the brain where the seizures
originate.
4.As
a
part
of
medical syndromes.

discrete,

identifiable

5.By the event that triggers the seizures, such as

reading or music
In
1981,
the International
League
Against
Epilepsy (ILAE) proposed a classification scheme for
individual seizures that remains in common use. This
classification is based on observation (clinical and
EEG) rather than the underlying pathophysiology or
anatomy and is outlined later on in this article. In
1989, the ILAE proposed a classification scheme for
epilepsies and epileptic syndromes. This can be
broadly described as a two-axis scheme having the
cause on one axis and the extent of localization
within the brain on the other. Since 1997, the ILAE
have been working on a new scheme that has five
axes: ictal phenomenon, (pertaining to an epileptic
seizure),
seizure
type,
syndrome,
etiology,
impairment.

Seizure types are organized firstly

according to whether the source of
the seizure within the brain is
localized
(partial or focal onset
seizures)
or
distributed
(generalized seizures).
Partial
seizures are further divided on
the
extent
to
which
consciousness is affected. If it is
unaffected, then it is a simple
partial seizure; otherwise it is
a complex partial (psychomotor) seizure. A partial
seizure may spread within the brain - a process
known as secondary generalization. Generalized
seizures are divided according to the effect on the
body but all involve loss of consciousness. These
include absence (petit
mal), myoclonic, clonic,
tonic, tonic-clonic (grand mal), and atonic seizures.
Children may exhibit behaviors that are easily
mistaken for epileptic seizures but are not caused by
epilepsy. These include:

Inattentive staring

Benign shudders (among children younger than

age 2, usually when they are tired or excited)

Self-gratification
head banging)

Conversion disorder (flailing and jerking of the

head, often in response to severe personal stress
such as physical abuse)

behaviors

(nodding,

rocking,

Conversion disorder can be distinguished from

epilepsy because the episodes never occur during
sleep and do not involve incontinence or self-injury.

Just as there are many types of seizures, there are

many types of epilepsy syndromes. Epilepsy
classification includes more information about the
person and the episodes than seizure type alone,
such as clinical features (e.g., behavior during the
seizure) and expected causes.
Each type of epilepsy presents with its own unique
combination of seizure type, typical age of onset,
EEG findings, treatment, and prognosis. The most
widespread classification of the epilepsies divides
epilepsy syndromes by location or distribution of
seizures (as revealed by the appearance of the
seizures and by EEG) and by cause. Syndromes are
divided
into
localization-related
epilepsies,
generalized epilepsies, or epilepsies of unknown
localization.

Localization-related epilepsies, sometimes termed

partial or focal epilepsies, arise from an epileptic
focus, a small portion of the brain that serves as the
irritant driving the epileptic response. Generalized
epilepsies, in contrast, arise from many independent
foci (multifocal epilepsies) or from epileptic circuits
that involve the whole brain. Epilepsies of unknown
localization remain unclear as to whether they arise
from a portion of the brain or from more widespread
circuits.
Epilepsy syndromes are further divided by
presumptive
cause:
idiopathic,
symptomatic,
and cryptogenic. In general, idiopathic epilepsies are
thought to arise from genetic abnormalities that lead
to
alteration
of
basic
neuronal
regulation. Symptomatic epilepsies arise from the

effects of an epileptic lesion, whether that lesion is

focal, such as a tumor, or a defect in metabolism
causing widespread injury to the brain. Cryptogenic
epilepsies involve a presumptive lesion that is
otherwise difficult or impossible to uncover during
evaluation.
The genetic component to epilepsy is receiving
particular interest from the scientific community.
Conditions such as ring chromosome 20 syndromes
are gaining acknowledgment, and although only 60
cases have been reported in the literature
since
1976,
"more
widespread
cytogenetic
chromosomal karyotyping in nonetiological cases of
epilepsy" is likely.
Some epileptic syndromes are difficult to fit within
this classification scheme and fall in the unknown
localization/etiology category. People with seizures
that occur only after specific precipitants ("provoked
seizures"), have "epilepsies" that fall into this
category. Febrileare an example of seizures bound to
a particular precipitant. Landau-Kleffner syndrome is
epilepsy that, because of its variety of EEG
distributions, falls uneasily in clear categories. What
can be even more confusing is that certain
syndromes, such as West syndrome, featuring
seizures such as infantile spasms, can be classified
as idiopathic, syndromic, or cryptogenic depending
on cause and can arise from both focal and
generalized epileptic lesions.

Epilepsy
is
usually
treated
with medication prescribed by a physician; primary
caregivers, neurologists,
and
neurosurgeons all
frequently care for people with epilepsy. However, it
has been stressed that accurate differentiation
between generalized and partial seizures is especially
important
in
determining
the
appropriate
treatment. In some cases the implantation of a
stimulator of the vagus nerve, or a special diet can
be helpful. Neurosurgical operations for epilepsy can
be palliative, reducing the frequency or severity of
seizures; or, in some patients, an operation can be
curative.
The proper initial response to a generalized tonicclonic epileptic seizure is to roll the person on the
side (recovery position) to prevent ingestion of fluids
into the lungs, which can result in choking and death.
Should the person regurgitate, this should be allowed
to drip out the side of the person's mouth. The
person should be prevented from self-injury by
moving them away from sharp edges, and placing
something soft beneath the head. If a seizure lasts
longer than 5 minutes, or if more than one seizure
occurs without regaining consciousness emergency
medical services should be contacted.

The mainstay of treatment of

epilepsy
is
anticonvulsant
medications.
Often,
anticonvulsant
medication
treatment will be life long
and can have major effects
on quality of life. The choice
among anticonvulsants and
their effectiveness differs by
epilepsy
syndrome.
Mechanisms,
effectiveness for particular epilepsy
syndromes, and side-effects differ among the
individual anticonvulsant medications. Some
general findings about the use of anticonvulsants
are outlined below.
Effectiveness - The definition of "effective" varies.
FDA approval usually requires that 50% of the patient
treatment group had at least a 50% improvement in
the rate of epileptic seizures. About 20% of patients
with epilepsy continue to have breakthrough epileptic
seizures despite best anticonvulsant treatment.
Safety and Side Effects - 88% of patients with
epilepsy, in a European survey, reported at least one
anticonvulsant related side-effect. Most side effects

are mild and "dose-related" and can often be avoided

or minimized by the use of the smallest effective
amount. Some examples include mood changes,
sleepiness,
or
unsteadiness
in
gait.
Some
anticonvulsant medications have "idiosyncratic" side
effects that can not be predicted by dose. Some
examples include drug rashes, liver toxicity
(hepatitis), or aplastic anemia. Safety includes the
consideration of teratogenicity (the effects of
medications on fetal development) when women with
epilepsy become pregnant.

Epilepsy surgery is an option for people with focal

seizures that remain resistant to treatment. The goal
for these procedures is total control of epileptic
seizures, although anticonvulsant medications may
still be required.
Certain
lesions
require Long-term
video-EEG
monitoring with the use of intracranial electrodes if
noninvasive testing was inadequate to identify the
epileptic focus or distinguish the surgical target from
normal brain tissue and function. Brain mapping by

the technique of cortical electrical stimulation are

other procedures used in the process of invasive
testing in some patients.
The most common surgeries are the resection of
lesions like tumors or arteriovenous malformations,
which, in the process of treating the underlying
lesion, often result in control of epileptic seizures
caused by these lesions.
Other lesions are more subtle and feature epilepsy as
the main or sole symptom. The most common form
of intractable epilepsy in these disorders in adults
is temporal lobe epilepsy with hippocampal sclerosis,
and the most common type of epilepsy surgery is
the anterior temporal lobectomy, or the removal of
the front portion of the temporal lobe including
the amygdala and hippocampus.
Some
neurosurgeons
recommend
selective
surgery
because of possible benefits in postoperative
memory or language function. Surgery for temporal
lobe epilepsy is effective, durable, and results in
decreased health care costs. Despite the efficacy of
epilepsy surgery, some patients decide not to
undergo surgery owing to fear or the uncertainty of
having a brain operation.
Palliative surgery for epilepsy is intended to reduce
the frequency or severity of seizures. Examples
are callosotomy or commissurotomy to
prevent
seizures from generalizing (spreading to involve the
entire brain), which results in a loss of consciousness.
This procedure can therefore prevent injury due to
the person falling to the ground after losing
consciousness. It is performed only when the seizures

cannot be controlled by other means. Multiple subpial

transections can also be used to decrease the spread
of seizures across the cortex especially when the
epileptic focus is located near important functional
areas of the cortex. Resective surgery can be
considered palliative if it is undertaken with the
expectation that it will reduce but not eliminate
seizures.

Beyond symptoms of the underlying diseases that

can be a part of certain epilepsies, people with
epilepsy are at risk for death from four main
problems: status
epilepticus (most
often
associatedwith anticonvulsant noncompliance), suicid
e associated with depression, trauma from seizures,
and Sudden Unexpected Death In Epilepsy
(SUDEP). Those at highest risk for epilepsy-related
deaths
usually
have
underlying
neurological
impairment or poorly controlled seizures; those with

more benign epilepsy syndromes have little risk for

epilepsy-related death.
The NICE National Sentinel Audit of Epilepsy-Related
Deaths, led by "Epilepsy Bereaved" drew attention to
this important problem. The Audit revealed; "1,000
deaths occur every year in the UK as a result of
epilepsy" and most of them are associated with
seizures and 42% of deaths were potentially
avoidable".
Certain diseases also seem to occur in higher than
expected rates in people with epilepsy, and the risk
of these "comorbidities" often varies with the
epilepsy
syndrome.
These
diseases
include depression and anxiety
disorders, migraine and
other
headaches, infertility and low sexual libido. Attentiondeficit/hyperactivity disorder (ADHD) affects three to
five times more children with epilepsy than children
in the general population. ADHD and epilepsy have
significant consequences on a child's behavioral,
learning, and social development. Epilepsy is
prevalent in autism.

In
the
past,
epilepsy
was
associated
with religious experiences
and
even demonic possession. In ancient times, epilepsy
was known as the "Sacred Disease" (as described in
a 5th century BC treatise by Hippocrates) because
people thought that epileptic seizures were a form of
attack by demons, or that the visions experienced by
persons with epilepsy were sent by the gods.
Among animist Hmong families,
for
example,
epilepsy was understood as an attack by an evil
spirit, but the affected person could become revered
as a shaman through these otherworldly experiences.
A chapter from a Babylonian textbook of medicine,
dating from about 2000BC and consisting of 40
tablets, records many of the different seizure types
we recognize today, and it emphasizes the
supernatural nature of epilepsy, while the Ayurvedic
text of Charaka Samhita (about 400BC), describes
epilepsy as "apasmara", i.e., "loss of consciousness".

In most cultures, persons with epilepsy have been

stigmatized, shunned, or even imprisoned; in
the Salptrire,
the
birthplace
of
modern
neurology, Jean-Martin Charcot found people with
epilepsy side-by-side with the mentally retarded,
those with chronic syphilis, and the criminally insane.
In Tanzania to this day, as with other parts of Africa,
epilepsy is associated with possession by evil spirits,
witchcraft, or poisoning and is believed by many to
be contagious. In ancient Rome, epilepsy was known
as the Morbus Comitialis ('disease of the assembly
hall') and was seen as a curse from the gods.
Stigma continues to this day, in both the public and
private spheres, but polls suggest it is generally
decreasing with time, at least in the developed
world; Hippocrates remarked that epilepsy would
cease to be considered divine the day it was
understood.

Many jurisdictions forbid certain activities to persons

suffering from epilepsy. The most commonly
prohibited activities involve operation of vehicles or
machinery, or other activities in which continuous
vigilance is required. However, there are usually

exceptions for those who can prove that they have

stabilized their condition. Those few whose seizures
do not cause impairment of consciousness, have a
lengthy aura preceding impairment of consciousness,
or whose seizures only arise from sleep, may be
exempt from such restrictions, depending on local
laws.
There
is
an
ongoing
debate
in bioethics over who should bear the burden of
ensuring that an epilepsy patient does not drive a car
or fly an airplane.

In the U.S., people with epilepsy can drive if their

seizures are controlled with treatment and they meet
the licensing requirements in their state. The amount
of time someone needs to be free of seizures varies
in different states, but is most likely to be between
three months and a year. The majority of the 50
states place the burden on patients to report their
condition to appropriate licensing authorities so that
their privileges can be revoked where appropriate. A
minority of states place the burden of reporting on
the patient's physician. After reporting is carried out,
it is usually the driver's licensing agency that decides
to revoke or restrict a driver's license.

Many notable people, past and present, have carried

the diagnosis of epilepsy. In many cases, their

epilepsy is a footnote to their accomplishments; for

some, it played an integral role in their fame.
Historical diagnoses of epilepsy are not always
certain; there is controversy about what is considered
an acceptable amount of evidence in support of such
a diagnosis.

A longitudinal study of epilepsy in

Kolkata, India.
Abstract

PURPOSE:
This study aimed to determine the prevalence,
incidence, and mortality rates of epilepsy in the city
of Kolkata, India. This is the first such longitudinal
study in a heterogeneous urban Indian population.
METHODS:
A two-stage door-to-door survey of a stratified
random sample was undertaken within the municipal
limits of Kolkata. Trained field workers detected and
interviewed the cases using a simple screening
questionnaire, and the detailed follow-up was done
by neurologists. The survey was conducted annually
for five consecutive years from March 2003 through
February 2008.
RESULTS:

A total of 52,377 (52.74% men) individuals were

screened. There were 309 prevalent and 66 incident
cases of active epilepsy. The prevalence and average
annual incidence rate (AAIR) with 95% confidence
interval (CI), age-standardized to World Standard
Population, were 572.8 (509.79-641.54) per 100,000
and 27.27 (21.03-34.80) per 100,000 per year,
respectively. The age-specific incidence rates of
epilepsy showed bimodal distribution. During the 5year period, 20 cases of active epilepsy died. The
average annual mortality rate (AAMR) was 7.63 (95%
CI 4.45-11.26) per 100,000 population per year.
Compared to the general population of Kolkata, the
all-cause standardized mortality ratio (SMR) for
persons with epilepsy was 2.58 overall (men 3.67;
women 1.77). There was no significant difference
between slum and nonslum dwellers in epidemiologic
parameters.

CONCLUSIONS:
The AAIR of epilepsy is comparable to that observed
in developed countries, but AAMR is higher. The allcause SMR for epilepsy relative to the general
population is, however, similar to that of developed
nations.
Wiley Periodicals, Inc. 2010 International League
Against Epilepsy.

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